A case of refractory bleeding postbulbar duodenal ulcer in a Lemierre's syndrome patient treated with gel immersion endoscopy

Abstract

A 66-year-old man visited our hospital and was diagnosed with Lemierre's syndrome. The patient also developed sepsis and was treated with antibiotics. NSAIDs and PPI were prescribed for the pain. On day 9 of hospitalization, the patient developed melena and presented with hemorrhagic shock. Emergency upper gastrointestinal endoscopy revealed multiple bleeding postbulbar duodenal ulcers and hemostasis was performed by clipping methods, hypertonic saline epinephrine local injection, and soft coagulation. Subsequently, he developed several more duodenal ulcers and on day 29 of hospitalization, the patient again developed melena and hypotension. Emergency upper gastrointestinal endoscopy revealed multiple bleeding postbulbar duodenal ulcers and since it was difficult to identify the bleeding point, hemostasis was performed by clipping methods using gel immersion endoscopy (GIE). The endoscopy on the 43rd day showed that the ulcer was improving, and the patient was discharged on the 58th day. GIE was useful in the hemostatic treatment of refractory bleeding postbulbar posterior duodenal ulcer.